I have been at Aravind Eye Hospital in Madurai, India for over six weeks now, and our projects have really begun to take shape and approach completion. I can’t say it was an easy start though. I am used to relying on myself to complete tasks or run experiments, but after working here for a few weeks, I learned that in order to really affect any change, I would have to work closely with the employees. I have never experienced the administration side of a hospital, and being introduced to it at Aravind has certainly been unique. The hospital operates like a machine, always moving from the second it opens its gates at 7:00am until past closing time (supposed to be at 5:30pm). Within that machine, my project is to get a quantitative analysis of patient information in the retina department and to propose ways to close any gaps.
The biggest problem so far had been getting that quantitative data. I spent a week generating and testing eight surveys (general and disease specific) only to find that there were very few patients who were able to fill it out themselves. I would receive surveys that had the first box checked for all the questions and others in which many questions were left unanswered. When I pointed these problems out to the patients, they went on long explanations in Tamil. Now the issue with this is that even though I look the part, I cannot understand a single word of Tamil. Although I don’t get the stares that the other Aravind interns get as they enter the hospital, on the flip side, all the patients and MLOPs (Mid-level Ophthalmic Personnel) assume that I am a local, or that I am at least able to understand the language. Not only do I not speak any Indian language, but even if I did, it would most likely be my parents’ mother tongue, Hindi. So I stand there and repeat the word “English” until the patient realizes that I don’t understand anything he/she is saying.
But even though this method had its difficulties, I was determined to make it work. I would sit in counseling for hours to come out with one or two poorly filled surveys. I would then try to sort through which answers seemed real, and which ones seemed to be the result of a lack of understanding. I thought that I would be able to fix it without getting help from my boss, but one week later, it became apparent that this method was not working.
Discouraged by my failure, I assumed that when I talked to my boss, she would not understand why I could not follow through. We had discussed my methods before I began developing the surveys, and she seemed to think they would work. But I was surprised to find that she understood why it did not work and suggested that we move to a more qualitative approach. I was assigned someone to help me run more open-ended focus groups. It was then that I realized, much like in lab work, there was going to be a lot of trial and error when it came to collecting the data. There is no perfect method, especially when dealing with people from whom you are separated by culture and language barriers. In the last few weeks I began to rely more on the people of Aravind who know the hospital and its patients. Every time I came up with a new idea or new version of something, I would run it by my boss, or the doctors and counseling sisters of the retina department. And even though I sometimes felt like I was holding back the flow of the clinic, I stopped hesitating so much when asking for help. As a result, I am now on my way to designing a smartphone app for the hospital, as well as developing information sheets pre- and post-discharge in order to stimulate shared-decision-making and dispense more tangible information.